The Home Birth Consensus Summit statements came out today, and a person who isn’t familiar with the issues and groups involved might well read them and wonder: Why are these even necessary? Aren’t a woman’s choices about childbirth already respected? Don’t doctors, midwives, nurses and mothers already communicate with one another? For this you needed a fancy summit (with really good food) in Virginia?

Can't we all just get along?

The answer: In a perfect world all this respecting and communicating would be done automatically, seamlessly, and without fuss and feathers. In that same perfect world the Mideast would be a haven of peace, too. The real world, though, is immensely messier. Given the history of animosity between some groups in the childbirthing world–most notably, between obstetricians and midwives–the fact that these statements were ever agreed upon is a minor miracle.

Let’s walk back in time for a moment. The conflict over who should help mothers birth their babies has been with us for quite a while, but not forever. In ancient times, in virtually all cultures, midwives attended to a mother during labor and to her baby afterward. Pain control, labor induction and augmentation, control of bleeding and such were managed through a combination of folk medicine and practical experience.

Things changed with the arrival of the Enlightenment, with its increasing emphasis on men (and they were nearly all men) of science and reason. The invention of forceps in the 1600s led to the establishment of obstetrics as a profession, again with men providing the muscle behind the technology. Midwives, with their “women’s work” and mysterious herbs and potions, came under an increasing suspicion that spilled beyond the confines of childbirth. It’s no coincidence that 22 of the 79 women tried for witchcraft at Salem, Massachusetts, were midwives.

The 20th century saw the near-extinction of midwives in much of the U.S., as the promise of safer births and the push for painless childbirth in turn “pushed” childbirth into the hospital. Where once nearly every baby was born at home, today the move to hospital birth is nearly complete–more than 96% of American babies are delivered in hospitals. Midwife-assisted home birth isn’t just frowned on by much of the obstetric community–it’s downright illegal in many states. And you wonder why midwives and obstetricians sometimes don’t get along?

That’s the context for this agreement, and it goes a long way to explain the remarkable nature of this document. The representatives of all the major midwifery organizations–MANA (Midwives Alliance of North America) and ACNM (American College of Nurse-Midwives–as well as ACOG (American College of Obstetricians and Gynecologists), FIGO (International Federation of Gynecology and Obstetrics, and the AAP (American Academy of Pediatrics) sat together in the same room to discuss home birth for probably the first time in history.

Next: Safety of home birth, communication among childbirth practitioners (or the lack thereof), and more…

Well done Mark! I have been attending birth for 36 years now and have become discouraged at how little progress is being made to merge the science with the sensitivity needed for the care of our mothers and babies. The summit gives me hope!

I was also very excited to see this consensus happen. I’ve worked with women and children as a nurse and now as a doula, and have been very frustrated with the seeming inability for anyone to come together to discuss issues. This is a big step in the right direction.

I thought it was legal for CNMs to attend home births in every state? I know in the majority of states they have to have a backup OB, but around 10 states they don’t have to have a backup OB. It’s only CPMs, DEMS, lay midwives who are illegal in some states?

In Alabama it was explicitly illegal for CNMs to attend home births until 1995. The law required that all CNM-attended births take place in hospitals. In 1995 the law was changed to bring CNMs together with NPs under Advanced Practice Nursing regulations. The hospital requirement was not stricken from the original law. Additionally, there are fewer than a dozen CNMs attending hospital births anywhere in the state because they cannot find supervising physicians to meet their “collaborative” practice agreement. Under their current professional atmosphere and stringent regulations, Alabama CNMs would find it impossible to attend home births. They would very likely lose their nursing license if they attempted to do so without a change in the law.

Any requirement in the law for a CNM to have a backup OB to attend home births is most often a means to prevent them from attending home births. While it may not be explicitly illegal in those states, if CNMs can’t find OBs willing to back them up, then CNM-attended home birth in those states becomes illegal in a practical sense.